No other business seems to have built in so much waste and inefficiency, or thrown up as many cultural barriers to teamwork as health care, the authors say. Some of their solutions are simple but elegant, like getting doctors, medical secretaries, physicians assistant’s and nurses to actually communicate with each other, and giving doctors five minutes between appointments to record notes on a patient.

But some ideas involve more complexity, like a complete restructuring of a cytology lab to reduce the rate of errors in Pap smear testing.

The book argues for the widespread adoption of new information technology, but warns that technology alone can’t improve health care: The clinicians have to be comfortable with it and engaged in its adoption. At MultiCare Health Systems in Tacoma, Wash., the authors say, it took 10 years to implement an electronic health record. Many lessons were learned the hard way, such as the importance of understanding exactly how the technology will work in the physician’s exam room before installing it.

The book offers checklists for adopting new technologies and fixing broken processes, while admonishing providers to keep their eye on the prize: The patient’s safety and the quality of care.

“Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience,” by former Boston Globe journalist Charles Kenney, offers an engaging account of a decade-long effort by the Seattle-based medical center to apply the lessons of the much-ballyhooed Toyota Production System to health care.

The hospital’s strides in improving efficiency and using good manufacturing procedures are impressive, such as paring down a massive backlog of patient appointments. But two years into adoption of the system, a patient dies from an injection that was meant to be contrast dye but was instead chlorhexidine, an antiseptic that is toxic when injected into a blood vessel. The event shatters the staff and makes it clear the journey to make the hospital safe for every patient has just begun.

The most compelling part of the story is the shift from a culture centered on the medical team to what is now widely known as “patient-centered care”: thinking about the needs of the patient and family, showing concern for dignity and privacy, and facilitating the healing process.

But the book also recognizes the nagging question underlying efforts to improve health care: Can the payment system change to support the kind of work the hospital accomplished? In a fee-for-service system, hospitals are paid for the quantity of care regardless of the quality.

“The system, in fact, pays fairly well for a great deal of substandard care that often provides no benefit to the patient,” the author writes. “From a purely financial standpoint, physicians and hospitals are often better off providing unnecessary care with little or no value to the patient.”

The hope, of course, is that by showing good outcomes with better-quality care, and taking out tons of waste, the financial incentives will be re-aligned for the good of the patient and the bottom line.

Comments (5 of 6)

"But two years into adoption of the system, a patient dies from an injection that was meant to be contrast dye but was instead chlorhexidine, an antiseptic that is toxic when injected into a blood vessel."

Errr, let's hear whether this was at a time when the EHR and CPOE were up and running, and tell us about the associated mayhem in the hospital at the time. There has got to be more to this vignette.

4:50 pm December 22, 2010

Doctor Zhivago wrote :

It seems like these folks are religious fanatics on the Crusades of HIT. Until there is vetting for safety and efficacy, these devices will remain meaningfully useless and poorly usable for the effective clinician.

When supposedly "world class" hospitals rid themselves of the seasoned nurses and other employees laden wisdom because they cost too much, and replace them with cheap labor not fit for purpose, patients die. This is happening through out the country.

Would the New England Patriots replace Tom Brady with a college quarterback because there will be savings? Why is it that the government thinks that nurse practitioners and physician assistants are the equals of primary care doctors because they can click on CPOE decision support cookbooks?

11:49 am December 22, 2010

Jeremy Engdahl-Johnson wrote :

Federal funding may be encouraging a move toward EHR, but there's more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=2193

10:15 pm December 21, 2010

Ed Chory wrote :

Required reading for everyone involved in health care, not just executives. The real question is whether business models are applicable to health care. Our system is not only terribly wasteful but also promotes overcomsumption. The cliche "more is not better" is ignored as we provide more care that may or may not be necessary or helpful. Until we develop a culture that everyone understands good health is something they must work for daily, not expect to obtain from a doctor or hospital we will not make any progress.
All the work to improve safety and quality of care is justified and necessary but all the systems and time outs can not prevent the tragedy described, infusion for chlorhexidene rather than contrast. Human error will never be eliminated, just minimized.